Healthcare Law Blog

AUGUST 3, 2022

is a reminder that the government will use the FCA to target medical device manufacturers for off-label use of medical devices, even where healthcare providers have decided the use is safe and effective. The government is attempting to prove materiality using Medicare’s coverage requirement that procedures must be “reasonable and necessary.”

Governance 52

Governance FDA Medicare Medicare 52

HIPAA Journal

JUNE 9, 2023

Prior to the Supreme Court ruling, there was no distinction between an identity thief stealing an individual’s identity and running up huge debts, a lawyer rounding up bills and only charging full hours, a waitress overcharging customers, and a doctor overbilling Medicaid. The Supreme Court decision related to the latter.

Fraud 107

Fraud Medicaid Medicaid Doctors 107

AIHC

SEPTEMBER 30, 2024

This was originally mandated by the Centers for Medicare & Medicaid Services (CMS) back in 1997 and implemented in 2004. The OIG made the following recommendations to Humana: Refund to the Federal Government the $6.8 HCC coding relies on ICD-10-CM coding to assign risk scores to patients.

Overpayments 52

Overpayments Overpayment Compliance Medicare 52

Hall Render

JANUARY 27, 2023

The main drivers of the increase in filings were increased labor and supply costs, interest rate increases, lack of government stimulus funds and lower investment returns. The Kaiser Family Foundation released a summary of all of the Medicaid Waivers (section 1115) that are pending or that have been approved by each state.

Medicaid 40

Medicaid Medicaid Hospitals Governance 40

AIHC

NOVEMBER 29, 2023

The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. Data Governance Metrics: These include metrics related to data cataloging, metadata management, and data stewardship practices.

Medicare 59

Medicare Medicare Medicaid Medicaid 59

AIHC

NOVEMBER 29, 2023

The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. Data Governance Metrics: These include metrics related to data cataloging, metadata management, and data stewardship practices.

Medicare 52

Medicare Medicare Medicaid Medicaid 52

Bill of Health

JANUARY 3, 2023

Some scholars have interpreted this to mean that the federal government has the right under the Commerce Clause to regulate all medical licensure. Gupta cites the Dormant Commerce Clause doctrine, a court-invented principle which allows the federal government to strike down state laws deemed excessively burdensome to interstate trade.

Licensing 130

Licensing Telemedicine Governance Federal Policy 130